Trevecca Nazarene University

Counseling Services
Counselors
Services
What To Expect
Counseling Services Inquiry Form

Trevecca Counseling Center
Online Services Request Form

Instructions—Please fill out this form below and click submit. You will be contacted for an appointment within 1 business day. This form will be kept confidential. Please call Amanda Daly, director of counseling services, at 615-248-1653 or email her at adaly@trevecca.edu if you have questions.

If this is an emergency or you are in a crisis, do not fill out this form. For immediate assistance, please contact your RA or RD or the crisis hotline at 615-244-7444 for aid during non-business hours (before 8:00 AM or after 4:30 PM).

First name

Last name

Gender

Male

Female

Date of birth

Campus phone number

Cell phone number

E-mail

Residence Hall (or commuting address)

Prefer male or female counselor

Male

Female

Current concern/reason for seeking counseling

Days/times of the week available to meet (counseling is offered between 9:00 AM and 3:30 PM on weekdays)

What is the best way to contact you for an appointment?

E-mail

Phone

Other

Counseling Services